​"If you're not stubborn, you'll give up on experiments too soon. And if you're not flexible, you'll pound your head against the wall and you won't see a different solution to a problem you're trying to solve." Jeff Bezos

This is an email I shared with parents that I wanted to post here also. It discusses the therapeutic benefits of play in my practice.

Hello,​As those who have been working with me over the last few years have noticed, we have been incorporating play increasingly into therapy in my office. I wanted to give a brief explanation why this is, and what the benefits of play can be when done in this environment. I want to start off with a few quotes about play.

“Play has been called the universal language of childhood. For many clients, it is a lost language. We are born with the instinct to play but, "Play only occurs when one is safe, secure and feeling good, which makes play an exceptionally sensitive measure for all things bad" (Panksepp & Biven, 2012, p. 355)…The pull toward play doesn't end with childhood. Play continues to shape our brains and bodies. Adults missing play opportunities are less curious, less imaginative, and lose a sense of joyful engagement in daily living (Brown & Vaughn, 2009).” (Dana, The Polyvagal Theory in Therapy: Engaging the Rhythm of Regulation, 2018)”“It stands outside ‘ordinary’ life and is non-serious but at the same time absorbing the player intensely. It has no particular goal other than itself. Play is not a specific behaviour, but any activity undertaken with a playful frame of mind. Psychiatrist Stuart Brown writes that play is ‘the basis of all art, games, books, sports, movies, fashion, fun, and wonder – in short, the basis of what we think of as civilization.’ (Brown 2009). As the noted play theorist Brian Sutton-Smith remarked, the opposite of play is not work, but depression.” (Goldstein J. , 2012)

“Research demonstrates that developmentally appropriate play with parents and peers is a singular opportunity to promote the social-emotional, cognitive, language, and self-regulation skills that build executive function and a prosocial brain. Furthermore, play supports the formation of the safe, stable, and nurturing relationships with all caregivers that children need to thrive.” (Yogman M, Garner A, Hutchinson J, Hirsh-Pasek, Kathy, Golinkoff, Roberta Michnick, AAP COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH, AAP COUNCIL ON COMMUNICATIONS AND MEDIA, 2018)

“Play is not frivolous: it enhances brain structure and function and promotes executive function (ie, the process of learning, rather than the content), which allow us to pursue goals and ignore distractions.” (Yogman M, Garner A, Hutchinson J, Hirsh-Pasek, Kathy, Golinkoff, Roberta Michnick, AAP COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH, AAP COUNCIL ON COMMUNICATIONS AND MEDIA, 2018) “Vygotsky believed that play was an essential element of learning that allows ways of internalizing and understanding the world.” (Carlisle, 2009)

As these quotes discuss, play has a unique role in the development of self-regulation, social connectedness, and executive function. These capacities, and the skills involved in them, develop over time within the context of this complex and free-flowing thing that we call play. They may be refined later in the classroom or in other settings, but it is in play that they are truly developed and honed. But, many children, adolescents, and yes, adults, don’t get the full benefit from play. They don’t develop self-regulation, social connectedness, or executive function skills. Or, for those who have, they may have lost them due to some type of illness, injury, or trauma. The definitive reasons why this may occur are probably too numerous to include in this brief discussion. They can probably be summarized as followed though:

Genetics

Epigenetics: “How experience changes gene expression.” (Siegel, 2018)

We will focus on the second one right now as this is the area that we can do the most with. Our brains, the wonderful distributed nervous system that goes throughout our bodies (Siegel, 2018), are modified and changed by the experiences that we have. These experiences change how genes express themselves, how neurons wire themselves, and how skills and capacities like regulation, executive functioning and social connectedness develop. And, that is the key to the play that we do in my office. We are looking to modify and enhance the experiences of individuals so that we can enhance a process that Daniel Siegel (2018) refers to by the acronym SNAG: Stimulate Neuronal Activation Growth. By doing so, we facilitate the opportunities for growth and development that may have been missed, and we facilitate the experiences that enhance the benefits of therapy that may not have been present with a different modality.I want to digress for just a moment here to talk about the Major Therapeutic Powers of Play (Schaefer & Drewes, 2014).

Play facilitates communication

It enhances self-expression

It allows the individual to express things that would otherwise be unavailable to them

It allows for the direct teaching of skills

It allows for the indirect teaching of skills

Fosters Emotional Wellness

It enhances positive emotions

It counter-conditions fears

It inoculates against stressors

It helps in stress management

Enhances Social Relationships (I will come back to this when I discuss Social or Interactive Play)

It improves attachment

It enhances social competence

It enhances empathy

Increases Personal Strengths

It enhances creative problem solving

It enhances resiliency

It accelerates psychological development

It enhances self-regulation

There are two key components to the ways that we enhance play in my office, the players, and the play itself. There are many different types of play. “The National Institute for Play (www.nifplay.org) identifies seven patterns of play. While each pattern of play can be enacted in a reciprocal, synchronous way, only attunement and social play are necessarily inter­active and thus predictably create a polyvagal play experience.” (Dana, The Polyvagal Theory in Therapy: Engaging the Rhythm of Regulation, 2018)

“Attunement play (the first play experience with infant-mother gaze, ongoing experiences of gaze­to-gaze resonance)”

“Body and movement play (play in motion)”

“Object play (early experience with manipulating objects, common adolescent or adult experiences of engaging with technology)”

“Social or interactive play (two or more people with involvement of the Social Engagement System)”

“Imaginative or pretend play (creating a different sense of story and place)”

“Storytelling or narrative play (hearing and telling personal stories)”

“Creative or fantasy play (transcending ordinary reality; using fantasy to shape and reshape ideas)”

We do a great deal with “Object play” particularly with games (and I will include a list of games at the end that are in my office and the skills that I’ve identified so far that they work on—I’m always identifying new skills), “Social or interactive play” (which is key and I will get to in just a moment), and with individuals as they need it “Imaginative or pretend play,” “Storytelling or narrative play,” and “Creative or fantasy play.” I want to focus on “Object play” and particularly the games that I have in my office for a moment. There are so many games today that allow us to focus on the different therapeutic powers of play. Their nature and rules lend themselves to focusing on the development of social connectedness, regulation, and executive functioning. The dynamic that they engender allows for the scaffolding that can be necessary so that individuals who need supports can be successful in playing them. Which is the key here, playing the game rather than winning; which unfortunately becomes the focus for many today in our society all too often. This can rob us of some of the benefits of play when we don't also have the enjoyment and connectedness while playing. There are many games today that allow us to work on these skills, and I’ve spent a great deal of time looking into how they may benefit individuals.

But, the second part may be even more important than the game. And, that is the players. To understand how important the actions of players are, there is a concept from Stephen Porges that is helpful: “Functionally, play is a neural exercise in which cues triggering neuroception alternate between danger and safety.” (Porges S. W., Play as a neural exercise: Insights from the Polyvagal Theory, 2018) Neuroception is a process in our nervous system that is pre-conscious where we determine whether we are safe, in danger, or in life-threat. Porges says that “…play is a blend of the social engagement system (neuroception of safety) and the sympathetic system (mobilization of the nervous system in the absence of danger). This blend of these two branches of the nervous system in play arises from the sense of engagement between the players, involving reciprocal face-to-face interactions that are constantly used to assess the intentionality of the actions of others (to make sure that it is “just play” and not aggressive or defensive in some way, as it would be in a fight–flight response generated by a neuroception of danger).(Kestly, 2014) So, it is vital for individuals who have had suboptimal play experiences in the past that have not developed social connectedness, regulation, and/or executive function skills that the individuals playing with them provide them cues that help to trigger safety.

Cues of safety include:

Relaxed face, chest, and stomach areas of players (so the absence of tension and stress in these areas). These areas may become tense briefly during the play, but they return to this relaxed state. (Porges S. , Polyvagal Theory, 2019)

Relaxed, warm, and expressive faces with “melodic voices.”*** (Winter, 2019) Faces may briefly change, as may the nature of the voice, but they return to the relaxed and warm nature of the face, and the rich, supportive nature of the voice.

Relaxed body postures, with open gestures. These again may change briefly but will return to this.

To the greatest extent possible, the environment is maintained free from noxious noises, smells and visuals that allow the individual to feel safe in proximity to the other players throughout the play. (Winter, 2019)

***melodic voices are rich, supportive, and nurturing

These are key to exercising the neurological system of the individual, which is an essential part of establishing the safety necessary for the individual to make gains on social connectedness, regulation, and executive functioning. If the play becomes too much about the game, or correcting actions, etc., then the individual can leave the sense of “play” and lose the “neural exercise” that occurs when the individual moves from sympathetic to parasympathetic systems. This loses the benefits to social connectedness, regulation, and executive functioning, and thus loses the therapeutic benefits of play. If the cues of safety are present throughout, then the individual can benefit maximally from the mechanics of the game (or other forms of play), and their system can learn the regulation (including emotion regulation, thought organization), executive functioning (including flexibility, impulse control, working memory, planning, organization, goal directed persistence), and social connectedness (including social thinking, synchrony, empathy, social rules).

Social interactive play done in this manner combined with other types of play (such as object play) works to develop the cognitive structures for social connectedness (by putting a brake on our sympathetic system and enhancing our neurological system around social connectedness {including the neurologic structures for social engagement, in particular Cranial Nerves X, XII, V, IX, and XI & Default Mode Network which has been “correlated with autobiographical recall, prospection (Spreng, Mar, & Kim, 2009), self-referential processing (Lanius, Bluhm, & Frewen, 2011), social cognition (Mars, et al. 2012), and moral sensitivity (Reniers, et al., 2012)” (Chan & Siegel, 2018)); executive functioning (“play stimulates production of a protein, ‘brain-derived neurotrophic factor’, in the amygdala and the prefrontal cortex, which are responsible for organising, monitoring, and planning for the future”) (Goldstein J. , 2012); and regulation (play enhances the ‘vagal brake’ (Porges S. W., Play as a neural exercise: Insights from the Polyvagal Theory, 2018); ““Safe, interactive play opportunities tone the nervous system. Through repeated experiences, the capacity of the Social Engagement System to regulate reactions is strengthened. Clients become more autonomically regulated and resilient in the face of stress.” (Dana, The Polyvagal Theory in Therapy: Engaging the Rhythm of Regulation, 2018)

I hope this brief discussion has helped to increase understanding of the power of play and how beneficial it truly can be. You will find the Games in My Office and Cues of Safety attached to this email.

I have uploaded the transcript for a podcast that I completed that ended up having some technical difficulties, and it has been put under the Polyvagal resource page. I will be re-recording the podcast in the next few days, and it will be uploaded to my podcast host at that time. The podcast is on the Polyvagal Theory and Speech Language Pathology.

In this third podcast on Sexuality and ASD Exploitation and Victimization, we will discuss the first part of reducing risks of victimization which is training of Individuals with ASD. This training goes far beyond just the sexual act, but rather goes into many of those aspects that individuals need to develop to be happy, healthy, and safe, including: personal rights, healthy self-concept, options for healthy sexual identity/orientation/expression, options for healthy gender identity and expression, relationship training, and sex education (including discussions of ASD specific factors). Here is the outline of the transcript for this podcast: response_to_risk_of_victimization.pdf. As always, my podcast can be found at: flexiblemindtherapy.podbean.com/ or on iTunes at: itunes.apple.com/us/podcast/the-flexiblemindtherapys-podcast/id1233264485. ​

I've updated some links on my Links page, including adding a couple of resources on music and ASD. I have added sections on Assessment and Checklists to the Executive Functions and Social Cognition pages.